Kathmandu
Cancer Center
Kathmandu
Cancer Center
Blood in the stool. A nagging change in bowel habits. Something that "doesn't feel right." Nepal's most common GI cancers — colon and rectal cancer — are also among the most preventable and treatable when caught early. The challenge is that most people dismiss the warning signs for years.
Reviewed by KCC's colorectal oncology team. Educational content — not personal medical advice. Last updated 2025.
Colorectal cancer is one of the few cancers that gives you warning signs before it becomes life-threatening — if you know what to watch for. The tragedy is that each of these symptoms has a more comfortable explanation that most people reach for first.
Haemorrhoids (piles/bawaasir) are extremely common in Nepal and do cause rectal bleeding. But here is the critical truth: colorectal cancer also bleeds — and piles and cancer can exist at the same time. A doctor who examines piles without also ruling out cancer higher up the bowel is not doing enough. If you have rectal bleeding plus any bowel habit change, weight loss, or anaemia, you need a colonoscopy — not just a haemorrhoid examination.
Call KCC: 01-6634300 — or go to the nearest emergency room for obstruction symptoms.
If someone in your family has been having "stomach problems," avoiding certain foods, or seems paler and more tired than usual — and they're putting off seeing a doctor — please act. Colorectal cancer found before it spreads is highly curable. Bring them to KCC for a consultation. It takes one afternoon.
Unlike most cancers, colorectal cancer has a well-defined pre-cancerous stage that can be detected and eliminated before a single cancer cell develops. Colonoscopy doesn't just find cancer early — it prevents cancer entirely.
Colorectal cancer almost always begins as a small, benign growth called an adenomatous polyp. Over 5–15 years, some polyps grow, develop abnormal cells, and eventually transform into invasive cancer. A colonoscopy can visualise and remove these polyps during the same procedure — before they ever become cancer. This is why colonoscopy screening reduces colorectal cancer mortality by 60–70% in well-studied populations. It is one of the most powerful cancer prevention tools in medicine.
When colonoscopy is not immediately accessible, stool-based tests offer a less invasive first step:
Increases Risk:
Reduces Risk:
For most colon cancers, the treatment sequence is clear: surgical resection first, then adjuvant (post-operative) chemotherapy for Stage III disease. Radiation therapy plays no routine role in colon cancer — a critical distinction from rectal cancer.
For suitable colon tumours, KCC's surgical oncologists perform colectomy — removal of the affected segment of colon.
Surgical Oncology at KCCRight hemicolectomy (ascending colon tumours), left hemicolectomy, sigmoid colectomy, or subtotal colectomy depending on tumour location. Crucially, KCC performs complete mesocolic excision (CME) — the colonic equivalent of TME in rectal surgery — which systematically removes the lymph node envelope and has been shown to reduce local recurrence significantly.
The liver is the most common site of colon cancer spread. For patients with resectable liver metastases, surgical removal of liver secondaries — combined with systemic chemotherapy — can achieve long-term survival and cure in selected patients. KCC evaluates all Stage IV patients with liver-limited disease for surgical resectability in the MDT setting.
Emergency surgery for obstructing or perforated colon cancer may require temporary colostomy (Hartmann's procedure). Planned colostomy reversal — once the patient has recovered and received adjuvant treatment — is performed at KCC. Stoma nurses provide dedicated support throughout.
For Stage III colon cancer (lymph node involvement), FOLFOX (oxaliplatin + leucovorin + 5-fluorouracil, fortnightly IV) given for 6 months after surgery reduces the chance of recurrence by approximately 25% and improves overall survival. Available at KCC's dedicated Day Care Chemotherapy unit — no hospital admission needed.
Chemotherapy at KCCCAPOX (capecitabine [oral tablets] + oxaliplatin, every 3 weeks) is an alternative to FOLFOX with equivalent efficacy. The oral capecitabine component reduces the number of hospital visits — particularly convenient for patients travelling from outside Kathmandu Valley. KCC's medical oncologists assess which regimen suits each patient.
For Stage IV disease, molecular testing guides targeted agent selection:
• Bevacizumab (anti-VEGF) — added to FOLFOX/FOLFIRI regardless of RAS status
• Cetuximab or Panitumumab (anti-EGFR) — for RAS/BRAF wild-type left-sided tumours
• Encorafenib + Cetuximab — for BRAF V600E-mutant second-line disease
All patients undergo RAS, BRAF, and MSI testing at KCC before metastatic treatment begins.
Approximately 15% of metastatic colon cancers are MSI-H / dMMR (mismatch repair deficient). These tumours respond dramatically to checkpoint inhibitors — pembrolizumab (first-line) achieves response rates and survival outcomes substantially superior to chemotherapy in this group. KCC performs MSI and MMR testing (IHC) on every colorectal cancer biopsy. Tumours that are MSI-H should generally receive immunotherapy rather than conventional chemotherapy.
The rectum sits deep in the pelvis, enclosed by bone. This means surgical access is technically challenging, margins are narrower, and local recurrence rates — if surgery alone is used for advanced tumours — are unacceptably high. Radiation therapy dramatically reduces local recurrence in rectal cancer and is now the standard of care for most locally advanced tumours (T3/T4 or node-positive). Moreover, delivering chemotherapy and radiation before surgery (neoadjuvant) shrinks the tumour, can achieve complete disappearance of cancer (pathological complete response) in many patients, and opens the door to organ preservation — avoiding surgery altogether. This opportunity does not exist in colon cancer.
Modern rectal cancer treatment has transformed dramatically. Where once every locally advanced rectal cancer meant certain surgery and often a permanent colostomy bag, today a meaningful proportion of patients can achieve complete tumour disappearance and keep their rectum — no surgery, no stoma. This requires a highly specialised team and an accurate treatment pathway.
5 fractions of radiation delivered over 1 week (5 × 5 Gy). Traditionally followed by surgery within days, but now increasingly used as the radiation phase of TNT — followed by systemic chemotherapy, and then delayed surgery or Watch & Wait. Advantages: faster, fewer hospital visits, lower acute toxicity during radiation. Downside: less immediate tumour shrinkage before surgery than long-course CRT.
Radiotherapy at KCC25–28 fractions of radiation over 5–6 weeks, given concurrently with low-dose capecitabine (oral chemotherapy radiosensitiser). Produces greater tumour shrinkage than SCRT alone. Standard of care for tumours where sphincter preservation requires maximum downstaging, or where CRM (circumferential resection margin) involvement is threatened. Surgery follows 8–12 weeks later.
For carefully selected small, early rectal tumours, contact brachytherapy delivers high-dose radiation directly to the tumour via a probe inserted into the rectum — an additional tool to achieve local tumour control and potentially enable organ preservation in patients unsuitable for major surgery. KCC's team discusses eligibility for all available local treatment options.
TNT is one of the most significant advances in rectal cancer management in decades. Instead of delivering some chemotherapy before surgery and some after, TNT gives all the chemotherapy and all the radiation before surgery — maximising tumour shrinkage, dramatically increasing the rate of complete cancer disappearance, and critically, creating more opportunities for organ preservation. The landmark RAPIDO and PRODIGE-23 trials established TNT as the new standard of care for locally advanced rectal cancer, and KCC follows this approach.
TNT regimen selection (SCRT-first vs CRT-first) is individualised based on tumour MRI stage, distance from anal verge, CRM status, and patient fitness. Discuss with KCC's colorectal MDT.
Perhaps the most transformative development in rectal cancer management: for patients who achieve a complete clinical response (cCR) — meaning no visible tumour on MRI, endoscopy and clinical examination after TNT or chemoradiation — surgery can be deferred indefinitely under close surveillance. This is Watch & Wait, or non-operative management (NOM).
Data from the International Watch & Wait Database (IWWD) covering over 1,000 patients shows that approximately 80–85% of cCR patients avoid surgery permanently. In the 15–25% who develop local regrowth, almost all are detectable early during surveillance and are salvageable with surgery at that point — with no worse long-term oncological outcome than had surgery been done upfront.
Watch & Wait is not "doing nothing" — it is an intensively monitored strategy requiring strict patient compliance. It is not appropriate for every patient who declines surgery. Eligibility is assessed by KCC's multidisciplinary team based on imaging, endoscopy, and individual clinical factors. Ask our team whether you or your family member might be a candidate.
The preferred surgery for rectal cancers above approximately 2–3 cm from the anal verge, where an adequate resection margin allows reconnection of the bowel (anastomosis) without sacrificing the sphincter. KCC performs Total Mesorectal Excision (TME) — the gold standard surgical technique — ensuring complete removal of the mesorectal envelope and dramatically reducing local recurrence. A temporary loop ileostomy is often formed to protect the anastomosis while it heals, and is reversed after 8–12 weeks.
Surgical Oncology at KCCFor tumours within 1–2 cm of the anal sphincter complex, where adequate surgical margins cannot be achieved with sphincter preservation, APR remains the appropriate operation. APR involves removal of the rectum, anus, and surrounding tissues, resulting in a permanent colostomy. KCC's team discusses this honestly and provides full stoma care support before, during and after surgery.
For selected early-stage rectal cancers (T1, selected T2) or large complex polyps, Transanal Endoscopic Microsurgery (TEM) or Transanal Minimally Invasive Surgery (TAMIS) allows precise resection of the rectal tumour entirely through the anus — avoiding any abdominal incision and completely preserving the rectum. This is the ultimate organ-preservation surgery. Strict criteria apply — patient selection is critical.
The exact pathway is individualised — this illustrates a typical TNT + Watch & Wait route for locally advanced rectal cancer.
Colonoscopy with biopsy · MRI pelvis (high-resolution, 3mm slices) · CT chest/abdomen/pelvis · MDT review. MRI defines: T stage, N stage, circumferential resection margin (CRM), distance from anus, extramural vascular invasion (EMVI).
FOLFOX or CAPOX × 4–6 cycles. Treats micrometastatic disease. Begins systemic tumour control. Delivered in KCC's Day Care unit — day patients, no admission needed.
Long-course CRT (25–28 fractions + oral capecitabine over 5–6 weeks) or Short-course RT (5 × 5Gy over 1 week). Targets the primary tumour and regional lymph nodes in the pelvis.
MRI pelvis (mrTRG grading) + flexible endoscopy + DRE. The critical decision point: Has the tumour completely disappeared (cCR)? If yes → Watch & Wait discussion. If residual tumour → Surgery.
No surgery. MRI + endoscopy every 3 months. ~80–85% remain in sustained complete response and never need surgery. Regrowth → salvage surgery, almost always curative.
Low Anterior Resection (LAR) with temporary ileostomy, or APR. Total Mesorectal Excision (TME) — gold standard technique. Benefit of TNT: tumour has already responded maximally, surgical margins are better.
CT scan every 6 months × 3 years, then annually. CEA monitoring. Colonoscopy at 1 year (polyp surveillance). Nutritional and functional support. Stoma reversal if applicable.
An accurate diagnosis and stage is the foundation of the right treatment. KCC offers the complete diagnostic pathway — endoscopy, pathology, molecular testing and precision imaging — in Nepal.
The diagnostic gold standard. A camera examines the entire large bowel, biopsies suspicious lesions, and removes polyps simultaneously. For rectal cancer, rigid sigmoidoscopy accurately measures the distance from the anal verge — critical for surgical planning.
Colonoscopy at KCCBiopsy tissue is processed for: histological type and grade · RAS (KRAS + NRAS) mutation status · BRAF V600E mutation · MSI / MMR status (by IHC and/or PCR) · HER2 amplification (selected cases). This molecular panel determines eligibility for targeted therapy and immunotherapy in every patient from the outset.
The most critical staging investigation for rectal cancer. MRI defines: T stage · N stage · CRM involvement (<1mm = threatened) · EMVI (extramural vascular invasion) · Distance from anal sphincter complex. MRI guides neoadjuvant strategy, surgical approach, and Watch & Wait eligibility.
Radiology at KCCCT chest, abdomen and pelvis detects liver metastases, lung secondaries, peritoneal disease and distant lymph nodes. Determines whether the cancer is localised (potentially curable) or metastatic. Repeated after neoadjuvant therapy to assess systemic response.
Carcinoembryonic antigen is checked at diagnosis, during treatment and at every follow-up visit. CEA normalisation after surgery is a good prognostic indicator. Rising CEA during surveillance is often the first indicator of recurrence — enabling earlier intervention.
Every colorectal cancer case at KCC is discussed at a formal Multidisciplinary Team meeting before any treatment starts — surgical oncologist, medical oncologist, radiation oncologist, radiologist, and pathologist together. No patient receives a plan from a single doctor working alone.
Colorectal cancer — particularly rectal cancer — demands coordinated expertise across surgery, radiation and medical oncology. KCC's team is built for this collaboration.
Low anterior resection (LAR) · APR · TEM/TAMIS local excision · Liver metastasectomy · Emergency colectomy · Stoma formation & reversal.
Long-course CRT with capecitabine · Short-course RT (SCRT) · TNT radiation planning · Image-guided IMRT/VMAT for pelvic tumours · Organ preservation strategy · SBRT for oligo-metastatic disease.
FOLFOX / CAPOX adjuvant & palliative chemotherapy · FOLFIRI · Bevacizumab · Cetuximab / Panitumumab · Pembrolizumab (MSI-H) · Encorafenib (BRAF V600E) · Metastatic CRC protocols including hepatic TACE.
You deserve a definitive answer, not weeks of wondering. A colonoscopy gives you certainty — and if cancer is found, KCC has the complete team to treat it.
KCC · Tathali , Bhaktapur · Sun–Fri · Accessible from all Kathmandu Valley
ठूलो आन्द्राको क्यान्सर (Colorectal Cancer) ठूलो आन्द्रा (Colon) र मलद्वार नजिकको भाग (Rectum) मा हुने क्यान्सर हो। यो नेपाल र विश्वभर तेजीले बढ्दो क्यान्सरहरूमध्ये एक हो। यसको महत्वपूर्ण कुरा के छ भने — सही समयमा स्क्रिनिङ गरे यो क्यान्सर हुनुअघि नै रोक्न सकिन्छ।
⚠️ सावधान: नेपालमा धेरैजना "बवासीर (haemorrhoids) होला" भनेर रगत आउनुलाई बेवास्ता गर्छन्। तर पेट क्यान्सरले पनि यस्तै रगत निकाल्छ। बवासीर र क्यान्सर एकैसाथ हुन सक्छन्। रगत आउनु भयो भने तुरुन्त डाक्टरलाई देखाउनुहोस्।
Colon क्यान्सरमा: पहिले शल्यक्रिया, त्यसपछि FOLFOX / CAPOX कीमोथेरापी।
रेडियोथेरापी सामान्यतः आवश्यक पर्दैन।
Rectal क्यान्सरमा: पहिले कीमोथेरापी + रेडियोथेरापी (TNT — Total Neoadjuvant Therapy)।
राम्रो प्रतिक्रिया भएमा शल्यक्रिया नगरीकन मात्र नजिकबाट अवलोकन (Watch & Wait) गर्न सकिन्छ —
आँत र मलद्वार बचाउन सकिन्छ। यो आधुनिक oncology को ठूलो उपलब्धि हो।
KCC, भक्तपुर: ठूलो आन्द्राको क्यान्सरको सम्पूर्ण उपचार नेपालमै ।